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Senate Committee Advances Chronic Care Bill

News  |  By MedPage Today  
   May 19, 2017

The bill targets services for chronically ill Medicare beneficiaries.

This article first appeared May 11, 2017 on Medpage Today.

by Joyce Frieden

The Senate Finance Committee unanimously approved a bill Thursday aimed at improving care for Medicare beneficiaries with chronic conditions.

The Creating High-Quality Results and Outcomes Necessary to Improve Chronic (CHRONIC) Care Act of 2017 would increase access to telehealth for Medicare beneficiaries with chronic illnesses -- including those in Medicare Advantage plans -- as well as provide more incentives for enrollees to receive care through accountable care organizations (ACOs). It also would extend the Independence at Home demonstration program to keep people in their homes rather than hospitals, allow reimbursement for more non-health and social services, and extend permanently MA Special Needs plans that target chronically ill beneficiaries.

"One thing we hear a lot from ACOs is they have trouble keeping beneficiaries in-house rather than going to a provider outside the ACO, and that makes it harder to coordinate their care," a committee aide said. "This bill says that if you go to a primary care doctor in the ACO, we'll reduce or eliminate your cost-sharing for that primary care service. That will make beneficiaries stick to the ACO, and bring down their costs."

Sen. Ron Wyden (D-Ore.), the committee's ranking member, told MedPage Today that the measure is "transformative." "This is a formal recognition that this package of services -- the focus on care at home, the focus on new technology, the expanded role for primary care and prevention, which inevitably leads to more non-physician providers -- is the beginning of our push to update the Medicare guarantee. That's why it's transformative."

"Medicare is a promise, a guarantee that you get these defined benefits -- but Medicare 2017 does not resemble Medicare 1965," when the program first began, he continued. Back then, "All we were doing is talking about Medicare Part A and Part B ... Now we've got Medicare Advantage, coordinated care, patient-centered programs, and fee-for-service. This bill will benefit seniors in each one of the major ways in which they get their Medicare."

As for having the bill move through the House, Wyden said he has been talking about the bill to House Speaker Paul Ryan (R-Wisc.) and House Ways & Means Committee Chairman Kevin Brady (R-Texas). "Obviously the fact we passed this 26-0 will send a powerful message. This is an extraordinary development."

Finance Committee chairman Orrin Hatch (R-Utah) praised the bipartisan teamwork involved in getting the bill through the committee. "Given the contentious nature of our nation's current healthcare debate, it's remarkable we're able to get to this point," he said. "This endeavor has been the very definition of a team effort."

Several committee members spoke about the amendments they wrote into the bill. "If we want to bend cost curve and improve healthcare around the nation, we must address the issue of non-adherence," said committee member Pat Roberts (R-Kan.). "Our amendment directs [the Department of Health and Human Services] to establish a process by which Medicare prescription drug plans can request Parts A and B claims data to promote appropriate use [of medications]."

Others spoke about amendments that weren't included in the bill, or measures that they wanted to work on separately. Sen. Rob Portman (R-Ohio) said he had wanted to make permanent the Medicare Independence at Home Program -- which provides services to keep beneficiaries with chronic illnesses at home rather than in nursing homes or other facilities "[but instead] we got a 2-year extension. We only got that because the [Congressional Budget Office] score is misleading."

However, "another 2 years will give us the data to convince CBO that we're right," he continued. "It's worked really well; in Ohio we got great results. On average, we saved $3,000 per beneficiary."

Sen. Ben Cardin (D-Md.) urged the committee to take up a permanent repeal of Medicare's cap on reimbursement for physical, occupational, and speech therapy services. "It makes no sense whatsoever, and it does impact where people can get their therapy services," said Cardin, who has introduced a bill on the issue. "It also discriminates against those who have the greatest need."

"We've taken steps to make sure the cap doesn't take effect," he added. "And we have the votes to pass a permanent repeal of the therapy cap; we just haven't [managed ] to get it done. I urge the chairman and ranking member to find a way to get this done."

If Congress wants to tackle the issue of chronic illness, it can't ignore obesity, said Sen. Bill Cassidy, MD (R-La.). "The fact is, if you look at what's driving chronic disease in our nation, it's obesity. You cannot address a program in chronic disease without first addressing this. That's why senators [Tom] Carper (D-Del.), [Chuck] Grassley (R-Iowa) and I have introduced the Treat and Reduce Obesity Act," which would expand the types of Medicare providers who could be reimbursed for intensive behavioral therapy for obesity, and would require Medicare to pay for obesity medications.

"I am hopeful we can move forward with this legislation in the future," Cassidy said, adding that a CBO cost estimate on the bill was still needed.

In an unusual marker of the bill's importance, after the committee meeting ended, Hatch and Wyden posed for a photo with members of their staff, who had worked on the bill for several years.

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